Selected Opioids/Barbiturates; Phenobarbital; Primidone Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Initially, both medicines can cause sedation or suppress your natural urge to breathe. Over time, the phenobarbital may speed up how quickly your liver processes your pain medicine.

What might happen:

Initially, you could have more side effects from both medicines, but after you have been on the combination for a while your pain medicine may not work as well.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to monitor you more closely to be sure that you are not having side effects and that both medications are working. Your medicine doses may need to be adjusted.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, slow heartbeat, coma.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. October, 2019.
  • 2.Apadaz (benzhydrocodone and acetaminophen) US prescribing information. KemPharm, Inc.. December, 2023.
  • 3.Suboxone sublingual tablet (buprenorphine and naloxone) prescribing information. Reckitt Benckiser Pharmaceuticals Inc. October, 2019.
  • 4.Butrans (buprenorphine) US prescribing information. Purdue Pharm L.P. September, 2018.
  • 5.Zohydro ER (hydrocodone bitarate) US prescribing information. Zogenix Inc. October, 2019.
  • 6.Demerol (meperidine hydrochloride) US prescribing information. Validus Pharmaceuticals LLC. December, 2023.
  • 7.OxyContin (oxycodone hydrochloride) US prescribing information. Perdue Pharma L.P. October, 2021.
  • 8.Dsuvia (sufentanil) sublingual tablet US prescribing information. AcelRx Pharmaceuticals, Inc. December, 2023.
  • 9.Anderson Gail D. Chapter 42: Pharmacokinetics and Drug Interactions. In: Wyllie's Treatment of Epilepsy: Principles and Practice, 5th Ed. 2011.
  • 10.Pond SM, Kretschzmar KM. Effect of phenytoin on meperidine clearance and normeperidine formation. Clin Pharmacol Ther 1981 Nov;30(5):680-6.
  • 11.Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. Substance Abuse and Mental Health Services Administration (US) 2004.
  • 12.McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict 2010 Jan-Feb; 19(1):4-16.
  • 13.USFood and Drug Administration. FDA Drug Safety Communication: FDA updates prescribing information for all opioid pain medicines to provide additional guidance for safe use. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-prescr ibing-information-all-opioid-pain-medicines-provide-additional-guidance-s afe-use?utm_medium=email&utm_source=govdelivery April 13, 2023.
  • 14.USFood and Drug Administration. FDA Drug Safety Communication: FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-hea lth-care-professionals-discuss-naloxone-all-patients-when-prescribing-opi oid-pain July 23, 2020.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.